Phimosis

Phimosis is the inability to retract the foreskin because of a narrow preputial ring. It affects about 1% of boys.

Causes:

• primary (physiological): without sign of scarring (1):
  • congenital - rare
• secondary (pathological): due to scarring from conditions such as (1)
  • recurrent balanitis
  • traumatic retraction of the foreskin
  • Balanitis xerotica et obliterans (2)

Presentation is with:

• poor stream
• ballooning of foreskin on micturition
• 'spraying' on micturition
• recurrent attacks of balanitis
• pain on intercourse in adults
• in severe cases, hydronephrosis

Treatment

Physiological phimosis

• since the foreskin becomes retractable with time these patients can be managed conservatively
• topical steroids can be applied to the preputial ring may be useful (2)

Pathological phimosis -

• circumcision
• a short course of topical corticosteroids may be beneficial in mild scarring (2)

References:

1. European Society for Paediatric Urology; Guidelines on paediatric urology. 2024 guidelines, available online.
2. (2) McGregor TB et al. Pathologic and physiologic phimosis. Can Fam Physician 2007;53(3):445-448